Managing mental health as lockdown restrictions ease this summer

It’s officially summer and we’re easing out of lockdown and into ‘normal’ life. But if you need help managing your mental health and wellbeing during this period of change, you’re not alone, as the SilverCloud Wales Online Cognitive Behavioural Therapy (CBT) team can explain.

SilverCloud Wales is an Online CBT service designed to help people aged 16+, experiencing mild to moderate anxiety, depression or stress, manage their mental health and wellbeing.

CBT works by encouraging you to challenge the way they think and behave so you’re better
equipped to deal with life’s problems.

There’s no need to be referred by a GP – you can sign-up for and access SilverCloud Wales anytime, anywhere, on your smartphone, tablet, laptop or desktop computer.

SilverCloud Wales is an NHS Wales service, run by Powys Teaching Health Board, and offers help for anxiety, depression, stress, sleep, money worries and more.

Choose one of the easy-to-use, interactive online mental health and wellbeing programmes to complete over 12 weeks and receive fortnightly feedback from a qualified SilverCloud Supporter, one of the mental health professionals whose role is to support users of the service.

SilverCloud Supporter Alexandra Birrell, explains why, if you need support managing your mental health and wellbeing, particularly with anxiety, as lockdown restrictions ease this summer, you’re not alone…

“The past 15 months have been unprecedented. None of us have ever experienced anything like this so no-one could have possibly known what to expect.

“At the core of anxiety is often a difficulty in dealing with uncertainty, and at the core of low mood is often feelings of powerlessness and lack of control.

“We were instructed to stay home, which impacted our interaction with our social support networks, which usually serve to protect us from difficult feelings. However, 15 months later and for many these conditions have become the new normal. Now, being able to venture out of the house and managing social interactions is what brings up feelings of uncertainty.

“Of course, people will have different feelings about this, depending on their situation.

"Some people are naturally cautious whereas others are embracing the opportunity to reconnect with loved ones. The difficulty is that these differences in boundaries are now something that we must learn how to communicate and navigate.

“The way that people navigate boundaries is often related to their self-esteem. People who struggle with their self-esteem tend to wonder whether their needs are important and may struggle to communicate them. If we struggle to communicate our needs, our needs may not be met which can then confirm the feeling that one’s needs are not important.

“SilverCloud Wales users choose one online programme to complete over 12 weeks, with fortnightly feedback from a SilverCloud Supporter. SilverCloud Supporters can give users access to additional modules if we feel they need more support in certain areas. The Communications and Relationships module is a popular one…

“The Communication and Relationships module starts out with a quiz to identify your unique communication style. For example, do you see your needs as more important, of equal importance, or less important than the needs of the people around you? Do other people know what you want and need?

“If you are struggling with communication, it may be that over the years you have learned to communicate in a way that is either too aggressive or too passive to get your needs met. This module offers support and advice around learning to communicate in an assertive, yet respectful way. It also focuses on strategies that may support you in improving the relationships in your life and making sure that you have a healthy support network to lean on when you start to struggle.

“The Self-Esteem module is another one that clients find useful and relevant to their experiences. This module looks at ‘self-talk’ - the way that we speak to ourselves.

“When we are struggling with low mood or anxiety, a common symptom is negative self- talk. We may find that we tend to berate ourselves or judge ourselves in a way that we never would with a loved one who was struggling. The Self-Esteem module offers support around building a practice of self-compassion by learning to offer ourselves kindness, support, understanding and tenderness rather than beating ourselves up, which only serves to make us feel worse.

“If we can improve our self-esteem and our belief that our feelings and our needs matter, this can also support us in navigating these end of lockdown boundaries with the people around us.

“The Relaxation module features a number of exercises that can be really beneficial. Users learn helpful relaxation techniques that can be used in day-to-day life to unwind and de-stress…

“In order to change longstanding habitual patterns or tendencies, we have to be able to slow down enough to notice those patterns. Many people struggling with anxiety feel that their mind is running a mile a minute, and that one thought seems to lead into the next which leads into the next and so on. These worries may be paired with physical sensations of anxiety such as a racing heart, difficulty breathing or a tight chest.

“When practising relaxation, many people report that as their body returns to a state of rest, their mind will slow down as well. It is from this place that we can catch what difficult thoughts are coming up, notice those patterns so we can start to challenge and change them.

“My advice for maintaining positive mental health and wellbeing for people trying to adjust to the ‘new normal’ over summer is…

“Each person will need to weigh up how they feel about the restrictions lifting and what is most beneficial for their own mental health. For some, seeing their loved ones will be supportive, whereas for others it will be a source of stress and will bring up feelings of awkwardness when trying to communicate this.

“Often, people find that their mental health starts to spiral and they don’t understand why it’s happening - they just know that they’re feeling increasingly distressed, low, or anxious, or a combination of all of these feelings.

“CBT provides a framework for understanding how some of the natural and automatic ways that human brains and bodies respond to uncertainty can actually serve to make us feel worse. In that sense, the journey of recovery can be about learning to focus on that which is still within our control, and finding empowerment through identifying coping strategies and ways of better managing our feelings.”

ONE SERVICE - THREE WAYS TO ACCESS

1.  SilverCloud Wales – The flagship service, available across Wales. 

This is a self-referral service which means that you can sign-up directly, without having to be referred by your GP or other healthcare professional. Choose one of the easy-to-use, interactive online mental health and wellbeing programmes to complete over 12 weeks and receive fortnightly feedback from your online SilverCloud Supporter, one of the mental health professionals whose role is to support users of the service. Find out more and sign-up here.

2.  SilverCloud Blended – A tailored version of SilverCloud for Powys residents. 

Choose one of the easy-to-use, interactive online mental health and wellbeing programmes to complete over 12 weeks and receive six face-to-face* sessions with an Online CBT practitioner whose role is to support users of the service. To find out more and signup, please contact: Ponthafren Association covering North Powys and Brecon & District - https://www.ponthafren.org.uk; Mid and North Powys Mind covering Mid Powys - https://mnpmind.org.uk/; or Ystradgynlais Mind - https://minditv.org.uk/.

*These may be telephone and email support sessions, depending on Covid restrictions.

3.  SilverCloud Workforce – A tailored version of SilverCloud specifically for NHS staff  

     and keyworkers. 

You'll have access to four online mental health and wellbeing programmes: Space for Resilience; Space from Stress; Space from COVID-19; Space for Sleep. This is an unsupported service so you will work your way through your programme of choice on your own, at your own pace. Sign up directly for the service without needing to be referred by your GP or other healthcare professional.

Visit https://cymru.silvercloudhealth.com/signup/ and enter access code WALES2020.

For more information about SilverCloud Wales online CBT

- If you have any queries, please email Silver.Cloud@Wales.nhs.uk or call 01874 712 428.

- Find us on Twitter: https://twitter.com/SilvercloudW

- Find us on Facebook: https://www.facebook.com/SilverCloudWales

The new normal for our Powys mental health charities

 

Back in July we had a really helpful roundup from our mental health charities in Powys, to find out how they had been innovating to ensure continued service provision for their members since the start of the Covid-19 pandemic.

We recently met with them again, and decided this would be perfect opportunity to do a further update to share more information about their services in this strange and challenging year.

Here is what they had to tell us about what’s been happening for them lately. 

Please note that this update was made earlier in December, before the Welsh Government's latest announcements about new Covid-19 restrictions were announced for Wales.

Ystradgynlais Mind

Ystradgynlais Mind has migrated the majority of its service to online platforms and telephone support. We have increased our social media presence. The result of expanding our social media presence has been the ability to engage with and support many more people, particularly young people. 

Gareth James & Iwan Evans raised £2000 for Ystradgynlais Mind on a running challenge

The impact of digital exclusion has become more apparent to us since the onset of Covid 19. We have attempted to overcome the impact of digital exclusion by the provision of some IT equipment via purchases made through ‘Computer Recyclers’ plus issuing repurposed mobile phones etc. We have also increased our one to one telephone support to those who are digitally excluded and provided pre-arranged ‘welfare checks’ for those who are not receiving the same level of support previously delivered via statutory services. 

Perinatal support is now being delivered via webinar alongside one to one counselling support and peer support groups. We have also extended perinatal support to partners. Counselling provision has been increased by 75% to address the increasing demand for counselling. Referrals to blended online SilverCloud CBT have increased, the practitioner is currently holding a waiting list. Active Monitoring has been able to fill the gaps left by blended counselling through the provision of printed supporting materials and telephone support - this service is operating at capacity. 

After receiving Zoom training a member is able to access online counselling

Yoga and Mindful meditation has all been migrated to remote delivery. These sessions are proving popular and participation has increased by 150%. Peer supporters are now facilitating twice weekly online/phone support sessions. This group is growing in size and service users involved are supporting one another to form their own social support networks, reducing social isolation and increasing their own personal resilience.

Brecon & District Mind

Some of the issues that have come up for Brecon & District Mind recently include employment, children with anxiety around school or Covid itself, and a lot of people are keen for the drop-in to restart, so we are doing that now ensuring people making appointments to attend. Also a lot of people are becoming agoraphobic because of the rules and regulations. And there is some worry about Christmas and issues around that.

We have returned to face to face meetings outside and walk & talk sessions, but had taken the decision not to open the centre before the firebreak lockdown. We are going back to 1:1 sessions (as well as the drop-in) by appointment only. We will continue our schools work with children and young people, ensuring that this is done safely. We are doing a lot of family work and safeguarding and are looking into extra/crisis support in the evenings. A recent survey has shown that people have appreciated the support they have received from us in the last year with comments like: “Don’t know what I would have done without (Brecon) Mind’s support”, “excellent service”, brilliant counselling."

Unfortunately as we speak the guidelines and regulations around Covid have changed yet again so we are now having to revert to remote services until the New Year when the Welsh Government will be reviewing the situation. There will be staff available over the Christmas period to offer support by phone should anyone need this. Our centre is now closed and staff mostly working from home.

The Green Minds project is continuing and Brecon Cathedral is funding this for 1 day a week. Our Mums Matter project is also continuing with a new Zoom course starting in January. Our blended work in partnership with the online SilverCloud CBT is quieter. However, we are doing more wellbeing calls by phone and having more referrals into that. A survey we did shows that people prefer 1:1/ face-to-face support and so we are busy with that.

We have been fortunate in securing funding to employ our first Digital Technical Officer who is helping us develop our digital service offering and upskilling staff and service users where needed.

Mid and North Powys Mind

Here at Mid and North Powys Mind we are seeing very high levels of demand overall across all of our services, including more complex cases requiring more time for our support workers. We expect this trend to continue through to Spring 2021.

An episode of THRIVE on Facebook

The team is providing a blended service of both online work, including blended online SilverCloud CBT, counselling and support work, as well as still providing face-to-face meetings as and when needed. This blended approach means we can still meet the high level of demand as phone sessions are usually shorter and do not require time for travel, whereas the face-to-face sessions are there for those clients who struggle with the remote support.

We had our first day back working in Builth and Llandrindod High Schools to offer support to students aged 16 and over - this support had been halted in January. We’re going in with a really open mind as obviously things have changed since the last time we were there. It’s a very different environment now and we are taking it slowly, working with the schools and students to co-produce the support for the greatest impact. We still have 2 weekly online youth group sessions that are well attended.

We were lucky to secure some space in the Armoury, thanks to Ponthafren Association, and have started to run our first face-to-face Mums Matter course in Welshpool. Seven mums attended, which is our highest number since lockdown started. Two more face-to-face Mums Matter courses will be running in January/February.

Our Outreach group in Knighton used to meet every week on a Friday, but has been operating via telephone support with help from dedicated volunteers since the first lockdown. Now with the help of Impelo (a local charity using dance to transform people's lives) we are hoping to run one face-to-face dance session a month in Knighton, giving group members a chance to meet in a safe and supportive environment.

In Llandrindod our Tai-Chi group is meeting again in Celf after not meeting for a time and briefly being held in the Rock Park. This group is going well and is supported by volunteers and a trained tutor.

Since March we have supported over 500 people through face to face or phone meetings. Live broadcasts have continued to be very popular. Our digital content on Facebook and Youtube has been well received and we have been producing videos on Mindfulness, Tai Chi, THRIVE tips and other wellbeing activities. On Facebook we have had over 68,000 minutes of our videos watched since March and have now reached over 30,000 people.

We continue to offer remote training via Zoom, this has been a huge success, with many people previously unable to attend due to travel now being able to access the support.

Ponthafren Association

At Ponthafren Association we have been continuing to provide our services. Face-to-face this is appointment-based only to reduce our numbers in the buildings. Zoom has become the go-to for most things which has been really positive. Two Zoom groups, crochet and afternoon tea, have been very popular. Plus the videos on how to make Christmas decorations. Life skills courses have been popular and there has been strong demand for anger management courses. We continue to see an increase for all our services whilst working in partnership with others such as the Newtown Network.

Lockdown has created the opportunity for some people to reflect and explore their gender and we are currently supporting a number of people around this.

The Armoury, our new building in Welshpool, is preparing to open which is great. The construction company Paveways provided free labour and materials to refurbish the building through their charity’s arm, and they have been fantastic. You can watch a video of the work here. 

It’s been truly magical how the community has supported Ponthafren to support others. Rory raised over £800 as Santa on a bike and Cathy Beech released a record to raise funds for us.

You can find out more about the services these organisations are offering on their websites (linked above) or Facebook pages where you will also see details of their Christmas and New Year opening times.

Wishing everyone a relaxing Christmas and a peaceful New Year, 

and hoping for brighter times in 2021!

The latest on SilverCloud - online Cognitive Behavioural Therapy

Becka Williams, Project Manager and Catrin Guest, Project Support Office & Online CBT Coordinator

by guest author Becka Williams

Project Manager, Powys Teaching Health Board

Following the implementation of our Online CBT service, SilverCloud, across Powys in May 2018, there has been a lot of work undertaken to develop the service and upscale it across Powys. 

We have received approximately 1100 referrals into the stand-alone service with referrals beings received from a range of different departments, services and healthcare professionals across the Health Board.

Work has commenced on the translation of the main Space from Anxiety and Depression programme and it is hoped that this will be ready for implementation by the end of 2019.

We were fortunate to win the Powys Teaching Health Board's Staff Excellence Award under the category of ‘Digital First’ in July which is a fantastic achievement. 

Becka Williams – Project Manager, Claire Cartwright – Director Ponthafren Association,
Jackie Jones & Sarah Dowler – Blended Online CBT Practitioners, Ponthafren

Blended Online CBT Service

We have implemented our Blended Online CBT service in partnership with Ponthafren Association in North Powys and the Mind Resource Centres in Mid and South Powys. The blended service offers access to the online platform as well as 6 face to face sessions with our Blended Online CBT Practitioners, during which they will review progress of the platform, signpost certain activities, tools and modules within the programmes and offer encouragement and support. The face to face sessions will be offered from the GP practices in Powys.

We are now ‘live’ with this service across nearly all GP practices, and where we have been unable to offer this from the specific practice, an alternative can be offered for the service users in that area should they wish to access this service.

Clinical referrals are required in to the blended service and these can currently be done through GPs of the Local Primary Mental Health Support Services (LPMHSS) within Powys Teaching Health Board.

We have currently received approximately 190 referrals into this service and are continuing to engage with the GPs and clinical teams to further upscale the blended approach.

Becka Williams, Project Manager & Catrin Guest, Project Support Office & Online CBT Coordinator raising awareness of Positive Body Image with PTHB's Occupational Health & Mental Health department during Mental Health Awareness Week

Positive Body Image

As part of Mental Health Awareness week, with ‘body image’ being the topic for 2019, we implemented our Space for Positive Body Image programme, which is now available for our healthcare professionals to refer in to.

This programme looks at the following topics:

• Improves understanding of body image and the impact on depression and anxiety.
• Focuses on what factors influence body image and how to improve perceptions of body image. 
• Introduces the known risk factors of eating disorders.
• Improves understanding of the effect of the media on understanding of the “ideal body”.
• Encourages reduction of individuals thin-ideal internalisation through analysis of media messages.
• Introduces self-esteem and focuses on where it comes from and how to boost it.
• Introduces the reciprocal relationship between how we feel and how we eat, using the CBT model of Thoughts Feelings Behaviours (TFB) cycle.
• Recognises emotional eating, mindful eating and how to have a healthy relationship with food.
• Recognises negative automatic thoughts and how to challenge them.
• Introduction to Mindfulness.
• Self-esteem enhancement through activities.
• Recognises the importance of social support in staying well.

Self-referral

We have designed, developed and recently implemented a self-referral option to this service. This service is available for all Powys residents and Powys patients that would like to self-refer onto an Online CBT Programme for depression, anxiety or stress. This service aims to offer services to those experiencing symptoms of depression, anxiety or stress who want access to an effective Online CBT therapy without having to first have an appointment with their local GP or other health professional.

People will be required to undertake an initial self-assessment and on successful completion of the self-assessment, immediate access to the online programme will be given. However, if the self-assessment results are not within the appropriate threshold for this service, a clinician from the PTHB Online CBT team will contact the person in due course for a follow up phone call assessment to determine whether the service is suitable for that person.

Sign up to the self-referral service here.

Student Programmes

The referral age for this service has now been lowered and therefore we are now accepting referrals for young people aged 16 years and above.

We have also implemented ‘student’ versions of 3 of our programmes: Space from stress, Space from anxiety and Space from depression which all offer support that relates more specifically to students such as educational stresses, friendships, relationships etc.

We have started to engage with the high schools and colleges across Powys to increase awareness of this availability to students.

Fionnuala Clayton, Psychological Assistant & Online CBT Coordinator & Catrin Guest, Project Support Office
& Online CBT Coordinator

All-Wales Roll-out

One of the key aims of this project was to explore the opportunity of implementing Online CBT across Wales, including the other Welsh Health Boards and third sector organisations.

Work has commenced on this and we went ‘live’ with the Welsh Ambulance Service NHS Trust (WAST) in December 2018 with this service being utilised within their Occupational Health and Staff Wellbeing teams.

We have also started working with Aneurin Bevan University Health Boards (ABUHB) with this service now being piloted within their Primary Care Mental Health Support Services (PCMHSS) and referrals being received since June 2019.

Engagement is still being undertaken with the other Welsh Health Boards, with a view to further roll-out this service across the different health board areas.

For further information on any aspects of the project or service, please check out this Powys Teaching Health Board website, or contact Becka Williams, Project Manager, on 01874 712 444 or becka.williams@wales.nhs.uk.

Introducing SilverCloud – online Cognitive Behavioural Therapy

Becka Williams, Project Manager, SilverCloud CBT

Last month I was pleased to accept an invitation to attend a Mental Health Partnership Board meeting at our Llandrindod offices, as it gave me the chance to find out more about the new online Cognitive Behavioural Therapy offering in Powys. It is called SilverCloud. 

Becka Williams, the Project Manager overseeing roll out of this new service across the county, gave us some background, an update on project progress and outlined plans for future development.

It was an interesting session to learn more about the new service, as individual representatives attend this quarterly partnership meeting. The reps are people who either have used, or care for somebody who has used, mental health services in Powys. Their role is to make sure user/carer voice is included in the planning of services, and here they were able to voice some immediate thoughts about online CBT.

Joy Garfitt, Assistant Director of Mental Health Services for Powys Teaching Health Board, began by explaining that CBT is a therapy that can help us think differently, particularly if we have unhelpful thoughts.

Background

Some regular readers may remember that we wrote about an earlier provision of online CBT in Powys, which was called Beating the Blues. This 3 year pilot scheme was spearheaded by a European funded project called Mastermind, but unfortunately engagement with this model was not brilliant. Out of 543 referrals to Beating the Blues, only 100 people completed the full course. Many disengaged with the process and some did not even start after being referred. Mastermind’s key aim, however, was to implement online therapies in rural areas across Europe, rather than to monitor the effectiveness of the actual CBT programme. But the project was invaluable in that many lessons were taken from this early work to help inform a new improved provision of online CBT in Powys.

In fact, many benefits of online CBT were identified directly as a result of the Mastermind scheme:

• Online CBT provides care closer to home – anytime, anywhere. 
• It reduces the number of unnecessary appointments. 
• It gives almost immediate access to therapy for people. 
• It reduces the travel time of people using services, carers and healthcare professionals. 
• It supports Prudent Healthcare – an approach at the heart of A Healthier Wales, the Welsh Government's long-term plan for health and care. 

The Welsh Government is now providing funding to continue and upscale online CBT not just in Powys but across the length and breadth of Wales. Powys Teaching Health Board is leading on the roll-out of SilverCloud across the country, starting with Powys. The aim is to:

• Increase options available to people experiencing mild / moderate anxiety and / or depression. 
• Reduce waiting lists / times by improving quicker access to therapies. 
• Improve equality of access to mental health care across both urban and rural areas.

Project progress 

SilverCloud online CBT went live in Powys on 1 May 2018. There are now 8 programmes available, including Space from Anxiety & Depression, Space from Stress and Space from Chronic Pain. Since the launch about 300 people have been referred to the programme, which can be accessed on smartphones and tablets as well as computers. Referrers can be GPs, Occupational Therapists, staff in the Community Mental Health, Local Primary Care and Long Term Conditions teams. In future people will be able to refer themselves onto the programme.

At this point in the meeting the individual reps began asking questions about managing risk. What happens if someone is considering self-harming? If it’s midnight? If someone is extremely lonely and this is all they have been offered to deal with their depression or anxiety? Joy described the online CBT as “adding another tool in the box for people”. It might not be right for those wanting face-to-face talking therapy, but others may prefer to do it privately. It is not aimed at people experiencing severe and enduring mental health issues. If someone has complex needs they will be referred to a different service. They may still access SilverCloud CBT but as an additional therapy to enhance what is already being done by mental health practitioners working to provide care in primary (via GP services) and secondary (via Community Mental Health) teams.

From day one when people register on SilverCloud, they have access to all the programmes for 12 months. Staff closely monitor their engagement with the platform for 3 months, but people can provide feedback for the whole period. Risk alerts are set in place, so that if anyone expresses an intention to self-harm they are contacted straight away and referred to a health care professional as appropriate. The service is monitored between 9am – 5pm during the week, but details of support / help out-of-hours are provided. Online CBT is not designed as an emergency response service.

People can write in journals as part of the programme, and choose to share (or not) the content with the online CBT co-ordinator. Some online content, such as the Mindfulness videos, can be downloaded onto a computer for future use. If access to an online device is not available people can use computers with privacy screens at their local libraries and further options will be available at Job Centres ultimately. Regular online reviews take place with the co-ordinator, and phone conversations are also possible. The whole process is confidential unless policies around safeguarding issues and / or criminal intent are set in motion.

Future development

Work is currently underway to further develop some of the strands of the online CBT, including:

• A combination of online CBT and face-to-face counselling, known as ‘blended’ counselling. The health board will be working with third sector organisations to provide additional support to some people using SilverCloud CBT. 
• The self-referral model for those who do not see their GP or access any other help. This will be the first time in Powys that open access is given to such a service and should be available in the New Year. 

Whilst Welsh translation of relevant forms and help pages has already taken place, the platform as a whole now needs to be translated. The design and roll-out of an All-Wales SilverCloud online CBT platform is then the key next step.

And, importantly, Becka is very keen to receive feedback from people who have used SilverCloud CBT, to help inform future development of the online provision in Powys and further afield.

If you have used SilverCloud online CBT and would like to let us know what you think, you can email us at mentalhealth@pavo.org.uk Alternatively contact Becka Williams directly at becka.williams@wales.nhs.uk

And what are your thoughts on online CBT generally? Let us know in the comments box below.

Feedback about SilverCloud CBT 

I found SilverCloud very easy to use and was surprised at how well developed and researched the platform was. 

I have found SilverCloud hugely useful in teaching me ways to improve my mental health and managing stressful situations. I am excited to continue using the skills I’ve learnt. 

I have been feeling more positive since taking part in this programme. I have been able to do simple things like taking the bus and going for a walk alone a lot more easily than about a month ago.